7th June 2017
During a routine inspection
We carried out an announced comprehensive inspection on 7 June 2017 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?
Our findings were:
Are services safe?
We found that this service was not providing safe care in accordance with the relevant regulations
Are services effective?
We found that this service was providing effective care in accordance with the relevant regulations
Are services caring?
We found that this service was providing caring services in accordance with the relevant regulations
Are services responsive?
We found that this service was providing responsive care in accordance with the relevant regulations
Are services well-led?
We found that this service was providing well-led care in accordance with the relevant regulations
Our key findings were:
- Staff told us that they felt supported to carry out their roles and responsibilities.
- We found feedback from patients was always positive about the care they received, the helpfulness of staff and the cleanliness of the premises.
- The provider had systems in place to monitor the quality of the service provided.
There were areas where the provider could make improvements and should:
- Review the risk assessment for chaperoning at the service and staff training requirements if necessary.
- Review procedures for the calibration of equipment including weighing scales.
- Review risk assessments with regard to medical emergencies and Legionella testing.
- Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.
- Review the process for starting medicines in people with a body mass index less than 30 kg/m2 to ensure that national guidance and the clinic policy is followed.
- Review the need for a T28 exemption from the Environment Agency to authorise denaturing of controlled drugs before disposal.
- Review and risk assess the appropriateness of having a family member as a translator.